Power Doppler sonography of cervical lymph nodes in patients with head and neck cancer.

PURPOSEThe purpose of this preliminary study was to evaluate the usefulness of power Doppler sonography in differentiating metastatic from nonmetastatic cervical lymph nodes in patients with cancer.METHODSHistologically proved metastatic (n = 71) and nonmetastatic (n = 220) lymph nodes were examined with power Doppler sonography in 77 patients with head and neck cancer. Power Doppler sonography was assessed for its ability to differentiate metastatic from nonmetastatic lymph nodes.RESULTSPower Doppler sonography showed characteristic features of parenchymal blood flow signal in 59 (83%) of the 71 metastatic lymph nodes. By contrast, only four (2%) of the 220 nonmetastatic nodes showed these power Doppler signals. In addition, power Doppler sonography showed high levels of sensitivity (83%) and specificity (98%) in depicting metastatic lymph nodes, which were superior to the values (66% sensitivity and 92% specificity) obtained by applying size criteria (transverse to longitudinal ratio). However, a combination of the two criteria (parenchymal color signal and transverse to longitudinal ratio) improved diagnostic accuracy to 92% sensitivity and 100% specificity.CONCLUSIONOur preliminary findings suggest that the power Doppler criteria of no hilar flow, peripheral parenchymal nodal flow, and a transverse to longitudinal ratio of more than 0.65 together constitute a powerful tool for depicting metastatic lymph nodes in patients with cancer.     

Discrimination of metastatic cervical lymph nodes with diffusion-weighted MR imaging in patients with head and neck cancer

BACKGROUND AND PURPOSE: Metastasis to the regional cervical lymph nodes may be associated with alterations in water diffusivity and microcirculation of the node. We tested whether diffusion-weighted MR imaging could discriminate metastatic nodes. METHODS: Diffusion-weighted echo-planar and T1- and T2-weighted MR imaging sequences were performed on histologically proved metastatic cervical lymph nodes (25 nodes), benign lymphadenopathy (25 nodes), and nodal lymphomas (five nodes). The apparent diffusion coefficient (ADC) was calculated by using two b factors (500 and 1000 s/mm(2)). RESULTS: The ADC was significantly greater in metastatic lymph nodes (0.410 +/- 0.105 x 10(-3) mm(2)/s, P <.01) than in benign lymphadenopathy (0.302 +/- 0.062 x 10(-3) mm(2)/s). Nodal lymphomas showed even lower levels of the ADC (0.223 +/- 0.056 x 10(-3) mm(2)/s). ADC criteria for metastatic nodes (>/= 0.400 x 10(-3) mm(2)/s) yielded a moderate negative predictive value (71%) and high positive predictive value (93%). Receiver operating characteristic analysis demonstrated that the criteria of abnormal signal intensity on T1- or T2-weighted images (A(z) = 0.8437 +/- 0.0230) and ADC (A(z) = 0.8440 +/- 0.0538) provided similar levels of diagnostic ability in differentiating metastatic nodes. The ADC from metastatic nodes from highly or moderately differentiated cancers (0.440 +/- 0.020 x 10(-3) mm(2)/s, P <.01) was significantly greater than that from poorly differentiated cancers (0.356 +/- 0.042 x 10(-3) mm(2)/s). CONCLUSION: Diffusion-weighted imaging is useful in discriminating metastatic nodes.     

Imaging of cervical lymph nodes in head and neck cancer: the basics

Imaging can identify pathologic cervical adenopathy in a significant number of patients with head and neck cancer who have no palpable adenopathy on physical examination. This article reviews nodal classification, drainage patterns of different head and neck cancers, various cross-sectional imaging features of metastatic lymph nodes from head and neck cancer, nodal staging, and certain features like extracapsular spread and carotid and vertebral invasion that the clinician should know because they have therapeutic and prognostic implications. New imaging techniques and the role of fluorodeoxyglucose positron emission tomography imaging in recurrent disease are discussed.     

Contrast-enhanced color Doppler sonography for evaluation of enlarged cervical lymph nodes in head and neck tumors

OBJECTIVE: We determined whether contrast-enhanced color Doppler sonography can differentiate benign from malignant enlarged cervical lymph nodes in head and neck tumors. SUBJECTS AND METHODS: Ninety-four enlarged lymph nodes in 39 adult patients (32 men and seven women; age range, 30-81 years) were examined with B-mode sonography and with unenhanced and contrast-enhanced color Doppler sonography. All patients had carcinoma of the oral cavity. Histologically, lymphadenitis was found in 57 nodes and metastases in 37 nodes. Geometric dimension, texture, and margin of the node and detection and location of vessels were noted. Histology and imaging findings were correlated. RESULTS: The transverse-to-longitudinal diameter ratio in combination with texture and margin analysis resulted in a correct diagnosis in only approximately 79% of the nodes. With contrast-enhanced color Doppler sonography, 86% of nodes showed vessels, and 28% of nodes showed vessels with this technique exclusively. Characteristic configurations were identified: hilar vessels with branching indicated lymphadenitis (sensitivity, 98%; specificity, 100%), and predominantly peripheral vessels indicated metastases (100%, 98%). These findings changed the diagnosis in 13 nodes, changed the therapy in four patients, and led to an incorrect diagnosis in one patient. CONCLUSION: Enlarged lymph nodes can be characterized as metastatic or inflammatory with high diagnostic accuracy on the basis of their vascular architecture as seen on contrast-enhanced color Doppler sonography.     

Comparison of sonography and CT for differentiating benign from malignant cervical lymph nodes in patients with squamous cell carcinoma of the head and neck

OBJECTIVE: We compared the ability of sonography and CT to differentiate benign from malignant cervical lymph nodes in patients with squamous cell carcinoma of the head and neck. MATERIALS AND METHODS: We analyzed 209 cervical nodes (102 metastatic and 107 nonmetastatic) from 62 patients with head and neck cancer. These nodes were topographically correlated by node between images and surgical specimens, and accordingly between sonography and CT. RESULTS: The area under the receiver operating characteristic curve (A(z) value) for the overall impressions of metastatic or nonmetastatic nodes was significantly greater for sonography (power Doppler sonography plus gray-scale sonography, 0.97 +/- 0.005; gray-scale sonography, 0.95 +/- 0.004) than for CT (0.87 +/- 0.018). Receiver operating characteristic curve analysis also showed that the greater ability of sonography to depict the internal architecture of the nodes (A(z) value, 0.96 +/- 0.006) compared with CT (A(z) value, 0.81 +/- 0.027) significantly contributed to the better performance of sonography compared with CT in diagnosing metastatic nodes in the neck. On the other hand, size criterion (the short-axis diameter) was equally predictive in sonography and CT. The greater contributions of internal architectures relative to the size criterion of the node in the sonographic assessment for metastatic nodes were further evidenced by the findings that sonography provided higher sensitivity and specificity than CT did, whereas the cutoff points for the short-axis diameter in both tests were equivalent. CONCLUSION: Sonography performed significantly better than CT in depicting cervical metastatic nodes. Sonography could be a useful adjunct to CT in surveying cervical metastatic nodes.     

Preoperative assessment of cervical lymph nodes in head and neck cancer with fluorine-18 fluorodeoxyglucose using a dual-head coincidence camera: a pilot study

The aim of this study was to investigate whether in patients with head and neck cancer, staging is possible with fluorine-18 fluorodeoxyglucose (¹⁸F-FDG) using a dual-head positron emission tomography (PET) camera. Twenty patients (ten men, ten women; mean age: 60 years) were studied using 185 MBq (5 mCi) ¹⁸F-FDG. Two of these patients who were suspected of having recurrence in the neck were restaged 19 and 12 months, respectively, after the resection of the primary tumour. The images were visually analyzed and the results were correlated with computed tomography (CT) (n = 18), ultrasonography (n = 17) and pathological findings. With respect to the primary tumour, FDG dual-head PET and CT revealed a sensitivity of 100% and 59%, respectively (P<0.001). In seven patients lymph node metastases were found in the neck specimen. Two of them had bilateral metastases. FDG dual-head PET correctly identified all nine pathological neck sides whereas CT and ultrasonography depicted eight of nine and seven of eight pathological sides, respectively. In three patients, false-positive FDG uptake was seen, which was due to a preceding biopsy in two cases. The sensitivity of FDG dual-head PET, CT and ultrasonography in the identification of pathological neck sides was 100%, 89% and 87%, respectively, and the specificity was 90%, 93% and 50%, respectively. With knowledge of the preceding biopsies, the specificity of FDG dual-head PET would have been 97%. The smallest lymph node metastasis detected by FDG dual-head PET that was missed by CT had a diameter of 0.6 cm. Measurement of ¹⁸F-FDG with a dual-head PET camera is very sensitive in the detection of primary head and neck cancers and accurate in the preoperative assessment of lymph node metastases. The results justify a prospective study on the identification of metastases in patients with head and neck cancer. In addition, it is justified to start a study on the detection of unknown primary tumours in patients with cervical metastases. Received 19 October and in revised form 18 December 1998     

Apparent diffusion coefficient for discriminating metastatic lymph nodes in patients with squamous cell carcinoma of the head and neck

PURPOSE

We aimed to evaluate the apparent diffusion coefficient (ADC) values of metastatic lymph nodes in patients with squamous cell carcinoma (SCC) of the head and neck.

METHODS

Patients with metastatic lymph nodes underwent 1.5 Tesla diffusion-weighted magnetic resonance imaging (MRI). The ADC values of the histologically proven metastases were evaluated retrospectively and mean ADC values were compared using one-way analysis of variance test. Receiver operating characteristic analysis was performed to identify ADC threshold values.

RESULTS

We included 33 patients (27 males, 6 females; mean age, 60.7 years) with 53 metastatic lymph nodes in the study. Mean ADC values for nodal metastases of nasopharyngeal carcinoma (NPC) (n=7), oropharyngeal (n=12), laryngeal (n=27), and hypopharyngeal (n=7) carcinoma were (0.810±0.158)×10⁻³ mm²/s, (0.985±0.099)×10⁻³ mm²/s, (1.037±0.150)×10⁻³ mm²/s, and (0.948±0.081)×10⁻³ mm²/s, respectively. The mean ADC values of nodal metastases of NPC were significantly lower than ADC values of laryngeal carcinoma (LSCC) (P = 0.002). An ADC value less than 0.890×10⁻³ mm²/s was found to facilitate differentiation of NPC from LSCC with a sensitivity of 71% and specificity of 85% (area under the curve, 0.852).

CONCLUSION

The mean ADC values showed significant differences between nodal metastases of NPC and LSCC. Considering SCCs as a single group may affect the accuracy of ADC-based differentiation. Location of the primary tumor should be taken into account and cutoff values should be determined separately for each anatomical location.Diffusion-weighted imaging (DWI) has the potential to characterize and differentiate various head and neck carcinomas (1–4). Differentiating nodal metastases of SCC from other less common tumors of the head and neck is important for treatment planning. Previous studies have shown that apparent diffusion coefficient (ADC) values may be used to differentiate metastatic lymph nodes due to SCC from lymphoma (5). However, the results of some studies indicated that ADC values of SCCs and their nodal metastases (e.g., poorly differentiated SCC and nasopharyngeal carcinoma) may sometimes overlap with the ADC values of lymphoma (5–7). Thus, the efficacy of using DWI for differentiation depends largely on the histologic characteristics of the lymph node.Approaching all pharyngeal space SCCs as a single homogeneous group may affect the accuracy of ADC-based discrimination of metastatic lymph nodes due to SCC from other tumors. Therefore, we aimed to retrospectively evaluate and compare the ADC values of metastatic lymph nodes from carcinoma of the nasopharynx, oropharynx, larynx, and hypopharynx.     

Preoperative assessment of cervical lymph nodes in head and neck cancer with fluorine-18 fluorodeoxyglucose using a dual-head coincidence camera: a pilot study.

The aim of this study was to investigate whether in patients with head and neck cancer, staging is possible with fluorine-18 fluorodeoxyglucose (18F-FDG) using a dual-head positron emission tomography (PET) camera. Twenty patients (ten men, ten women; mean age: 60 years) were studied using 185 MBq (5 mCi) 18F-FDG. Two of these patients who were suspected of having recurrence in the neck were restaged 19 and 12 months, respectively, after the resection of the primary tumour. The images were visually analyzed and the results were correlated with computed tomography (CT) (n = 18), ultrasonography (n = 17) and pathological findings. With respect to the primary tumour, FDG dual-head PET and CT revealed a sensitivity of 100% and 59%, respectively (P < 0.001). In seven patients lymph node metastases were found in the neck specimen. Two of them had bilateral metastases. FDG dual-head PET correctly identified all nine pathological neck sides whereas CT and ultrasonography depicted eight of nine and seven of eight pathological sides, respectively. In three patients, false-positive FDG uptake was seen, which was due to a preceding biopsy in two cases. The sensitivity of FDG dual-head PET, CT and ultrasonography in the identification of pathological neck sides was 100%, 89% and 87%, respectively, and the specificity was 90%, 93% and 50%, respectively. With knowledge of the preceding biopsies, the specificity of FDG dual-head PET would have been 97%. The smallest lymph node metastasis detected by FDG dual-head PET that was missed by CT had a diameter of 0.6 cm. Measurement of 18F-FDG with a dual-head PET camera is very sensitive in the detection of primary head and neck cancers and accurate in the preoperative assessment of lymph node metastases. The results justify a prospective study on the identification of metastases in patients with head and neck cancer. In addition, it is justified to start a study on the detection of unknown primary tumours in patients with cervical metastases.     

18F-FLT PET does not discriminate between reactive and metastatic lymph nodes in primary head and neck cancer patients.

Repopulation of clonogenic tumor cells is inversely correlated with radiation treatment outcome in head and neck squamous cell carcinomas. A functional imaging tool to assess the proliferative activity of tumors could improve patient selection for treatment modifications and could be used for evaluation of early treatment response. The PET tracer 3'-deoxy-3'-(18)F-fluorothymidine ((18)F-FLT) can image tumor cell proliferation before and during radiotherapy, and it may provide biologic tumor information useful in radiotherapy planning. In the present study, the value of (18)F-FLT PET in determining the lymph node status in squamous cell carcinoma of the head and neck was assessed, with pathology as the gold standard. METHODS: Ten patients with newly diagnosed stage II-IV squamous cell carcinoma of the head and neck underwent (18)F-FLT PET before surgical tumor resection with lymph node dissection. Emission (18)F-FLT PET and CT images of the head and neck were recorded and fused, and standardized uptake values (SUVs) were calculated. From all 18 (18)F-FLT PET-positive lymph node levels and from 8 (18)F-FLT PET-negative controls, paraffin-embedded lymph node sections were stained and analyzed for the endogenous proliferation marker Ki-67 and for the preoperatively administered proliferation marker iododeoxyuridine. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for (18)F-FLT PET. RESULTS: Primary tumor sites were oral cavity (n=7), larynx (n=2), and maxillary sinus (n=1). Nine of the 10 patients examined had (18)F-FLT PET-positive lymph nodes (SUV(mean): median, 1.2; range, 0.8-2.9), but only 3 of these patients had histologically proven metastases. All metastatic lymph nodes showed Ki-67 and iododeoxyuridine staining in tumor cells. In the remaining 7 patients, there was abundant Ki-67 and iododeoxyuridine staining of B-lymphocytes in germinal centers in PET-positive lymph nodes, explaining the high rate of false-positive findings. The sensitivity, specificity, positive predictive value, and negative predictive value of (18)F-FLT PET were 100%, 16.7%, 37.5%, and 100%, respectively. CONCLUSION: In head and neck cancer patients, (18)F-FLT PET showed uptake in metastatic as well as in nonmetastatic reactive lymph nodes, the latter due to reactive B-lymphocyte proliferation. Because of the low specificity, (18)F-FLT PET is not suitable for assessment of pretreatment lymph node status. This observation may also negatively influence the utility of (18)F-FLT PET for early treatment response evaluation of small metastatic nodes.     

Multivariate feature analysis of sonographic findings of metastatic cervical lymph nodes: contribution of blood flow features revealed by power Doppler sonography for predicting metastasis

BACKGROUND AND PURPOSE: Sonographic criteria of the lymph node have been found to be good indicators for metastatic lymph nodes. We determined which sonographic features are most predictive of metastasis in cervical lymph nodes among patients with head and neck cancer. METHODS: Gray-scale and power Doppler sonograms were retrospectively analyzed in 133 cervical lymph nodes (57 metastatic and 76 reactive nodes) from 52 patients with head and neck cancer. The gray-scale sonographic features of the presence or absence of hilar echoes, parenchymal echogenicity, and short and long axis lengths as well as the power Doppler features of normal hilar flow and abnormal parenchymal flow were evaluated. Univariate and multivariate logistic regression analyses were conducted to determine the relative value of each sonographic feature. RESULTS: At univariate analysis, all sonographic features assessed were found to be important. Multivariate analysis, however, suggested that the presence or absence of hilar echoes, increases in short axis length, and the presence of normal hilar flow were the only sonographic features that were predictive of reactive (presence of hilar echoes and hilar flow) and metastatic (increases in short axis length) lymph nodes. Although multivariate analysis did not indicate any significant contribution of the color-flow criteria for predicting metastatic nodes, the color-flow criteria appeared to improve the overall diagnostic accuracy for the less experienced observer. CONCLUSION: The sonographic criteria most predictive of metastatic cervical lymph nodes were absent hilar echoes and increases in short axis length, as assessed by logistic regression analysis. Compared with these gray-scale criteria, color-flow criteria had fewer predictive advantages.     

Value of accurate diagnosis for metastatic supraclavicular lymph nodes in breast cancer: assessment with neck US,CT, and 18F-FDG PET/CT

PURPOSENeck ultrasonography (US), computed tomography (CT), and ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) are all known to be useful imaging modalities for detecting supraclavicular lymph node (SCN) metastasis in breast cancer. The authors compared the diagnostic values of neck US, CT, and PET/CT in the detection of SCN metastasis in breast cancer.METHODSSCN metastases identified in neck US, CT, or PET/CT during follow-up visits of patients with breast cancer were pathologically confirmed with the use of US-guided fine-needle aspiration cytology. The clinicopathological factors of the patients were analyzed, and the statistical parameters including sensitivity, specificity, positive and negative predictive values, false-positive and false-negative rates, and accuracy of neck US, CT, and PET/CT were compared.RESULTSAmong 32 cases of suspicious SCNs, 24 were pathologically confirmed as metastasis of breast cancer. The sensitivity of US + CT was 91.7%, which was the same as that of PET/CT, while the sensitivity rates of US alone and CT alone were 87.5% and 83.3%, respectively. Accuracy was 99.8% in PET/CT alone and 98.1% in US + CT. The false-negative rate was 0.1% in US + PET/CT, while it was 0.2% in PET/CT and US + CT, 0.3% in US alone and 0.4% in CT alone.CONCLUSIONPET/CT can be the first choice for detecting SCN metastases in breast cancer. However, if PET/CT is unavailable for any reason, US + CT could be a good second option to avoid false-negative results.

The overall survival and mortality rates of patients with cancer have improved with early diagnosis and the development of new treatment modalities (1–4). However, paradoxically, the incidence of recurrence or metastasis has increased with the prolonged overall survival period.Supraclavicular lymph nodes (SCNs) are one of the common sites of regional recurrence of breast cancer. The breast cancer recurrence in the axillary lymph nodes is generally surgically removable and shows better prognosis than the recurrence in supraclavicular lymph nodes (SCNs), which does not show good prognosis even if it has been removed because of concurrent or subsequent distant metastases (5). However, early detection of SCN metastasis may improve the operability and expand the opportunities for curative therapy (6–8).Neck ultrasonography (US), computed tomography (CT), and ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) have been used for the detection of SCN metastasis in breast cancer (9–11). According to the National Comprehensive Cancer Network (NCCN) guidelines, although diagnostic contrast-enhanced chest CT is only recommended for clinical stages I–IIB with pulmonary symptoms, suspicious SCNs can be incidentally detected on neck areas shown in chest CT images (12).Based on several studies, the sensitivity and specificity were 75%–100% and 55%–99% for US, 25%–98% and 65%–99% for CT, and 74%–92% and 61%–79% for PET/CT, respectively (13–16). However, to the authors’ knowledge, there is no study that compares various imaging modalities for the detection of SCN metastasis in breast cancer. Herein, the authors compared the statistical parameters of neck US, CT, and PET/CT in detecting SCN metastasis in breast cancer.     

Assessment of cervical lymph node metastases using FDG-PET in patients with head and neck cancer

OBJECTIVE: To evaluate the diagnostic accuracy of fluorodeoxyglucose positron emission tomography (FDG-PET) relative to computed tomography (CT) for detecting metastatic cervical lymph nodes in patients with squamous cell carcinoma of the head and neck (HNSCC), and to ascertain the factors that affect this accuracy. METHODS: A total of 1076 lymph nodes obtained from 35 neck dissections in 26 HNSCC patients who preoperatively underwent both FDG-PET and CT were retrospectively analyzed. For pathological metastatic lymph nodes, the lymph node size (short-axis diameter), the ratio of intranodal tumor deposits, and the size of intranodal tumor deposits (maximum diameter of metastatic foci in each lymph node) were histologically recorded. RESULTS: Forty-six lymph nodes from 23 neck sides were pathologically diagnosed metastases. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of FDG-PET evaluated individually per neck side were 74%, 92%, 80%, 94%, and 65%, respectively, whereas those of CT were 78%, 58%, 71%, 78%, and 58%, respectively. FDG-PET detected 100% of metastatic lymph nodes > or =10 mm, intranodal tumor deposits > or =9 mm, and intranodal tumor deposits with a ratio >75%, whereas no nodes or tumor deposits smaller than 5 mm were detected. The spatial resolution limitations of FDG-PET were responsible for 16 of 20 (80%) false-negative PET results in lymph nodes. CONCLUSIONS: FDG-PET is a useful tool for preoperative evaluation of the neck because it accurately detects metastatic lymph nodes > or =10 mm and has fewer false-positive cases than CT. The high specificity of FDG-PET for lymph node metastases may play an important role in avoiding unnecessary neck dissection.     

Survival of patients with head and neck cancer

Background

Prognostic factors (e.g., gender, tumor stage, and hypoxia) have an impact on survival in patients with head and neck cancer. Thus, the impact of physical status and comorbidities on treatment decision and survival were evaluated.

Patients and methods

A total of 169 primary, inoperable patients with squamous cell cancer of the head and neck were retrospectively investigated. Patients were treated with hyperfractionated accelerated radio(chemo)therapy (HARcT) or hypofractionated radio(chemo)therapy (HypoRcT). Depending on the individual patient??s situation (Karnofsky Performance Index, KPI), treatment for patients with a KPI of 80?C100% was generally radiochemotherapy and for patients with a KPI????70% treatment was radiotherapy alone. In addition, all comorbidities were evaluated. Uni- and multivariate proportional hazards model were used, and overall survival (OS) was estimated by the Kaplan?CMeier method.

Results

Treatment consisted of HARcT for 76?patients (45%), HART for 28?patients (17%), HypoRcT for 14?patients(8%), and HypoRT for 51?patients (30%). Of the patients, 107?patients (63%) presented with a KPI of 80?C100%. OS (20%) was significantly better for patients with a KPI of 80?C100%, while the OS for patients with a KPI????70% was 8% (p??70?Gy), and chemotherapy were significant prognostic factors for better OS.

Conclusion

Our retrospective analysis shows that performance status with dependency on comorbidities was an independent risk factor for OS.     

甲状腺癌颈部转移性淋巴结的CT表现

目的研究甲状腺癌颈部淋巴结转移的CT表现。方法18例经手术或活组织检查证实的甲状腺癌颈淋巴结转移患者，包括17例腺癌和1例鳞状细胞癌均经CT平扫和增强扫描。对所有患者颈淋巴结转移的CT表现作回顾性分析。结果CT增强扫描显示，所有患者颈淋巴结转移表现为明显均匀强化，其强化程度与正常血管及甲状腺相接近。其中，8例伴有淋巴结内细颗粒状钙化。转移性淋巴结主要分布于Ⅵ和Ⅶ区，其次为Ⅱ、Ⅲ、Ⅳ区。结论增强CT上所显示的明显均匀强化和部分伴有淋巴结内钙化是诊断甲状腺癌颈淋巴结转移的有意义特征。     

Turbo short tau inversion recovery imaging for metastatic node screening in patients with head and neck cancer

BACKGROUND AND PURPOSE: A rapid and sensitive MR imaging technique would be beneficial for screening of metastatic nodes in the neck. We preliminarily evaluated the coronal MR imaging with a turbo short tau inversion recovery (STIR) sequence for that purpose. METHODS: The coronal turbo STIR imaging (repetition time [TR]/echo time [TE]/inversion time [TI] = 3850 ms/20 or 80 ms/180 ms) and axial fat-suppressed spectral presaturation with inversion recovery (SPIR) T2-weighted imaging (fsT2WI) (TR/TE = 3500 ms/80 ms) were performed on 29 patients with head and neck cancer. We obtained coronal turbo STIR images and axial fsT2WI of the necks. The section thickness, intersection gap, matrix size, and field of view were the same in both techniques. The diagnostic ability for metastatic nodes was assessed at each neck level by using various cutoff size criteria. The nodal involvement was confirmed by histologic examination. RESULTS: The image acquisition time for the whole neck by coronal turbo STIR and axial fsT2WI techniques was approximately 2 minutes and 4 minutes, respectively. When the size criteria (cutoff sizes of short axis diameter were 8 mm at level I and 5 mm at levels II and III) were used, the STIR imaging yielded compromised diagnostic ability having 100% sensitivity and 100% negative predictive value (NPV). fsT2WI technique yielded 100 sensitivity and 100% NPV by using cutoff sizes of 6 mm at levels I and II and 5 mm at level III. CONCLUSION: Coronal STIR imaging provided a rapid screening technique for cervical metastatic nodes and could be a diagnostic tool before detailed MR studies of the neck.